! ! ! Urinary Incontinence ! ! !What is urinary incontinence? Leakage of urine is called urinary incontinence. Some women leak small amounts of !urine. At other times, leakage of urine is frequent or severe. !Are there different types of urinary incontinence? !There are several types of urinary incontinence: • Stress urinary incontinence is loss of urine when a woman coughs, laughs, or sneezes. Leaks also can happen when a woman walks, runs, or exercises. It is caused by a weakening of the tissues that support the bladder or the muscles of the ! urethra. • Urge incontinence is leakage of urine caused by overactive bladder muscles that ! contract too often or problems with the nerves that send signals to the bladder !• Mixed incontinence is a combination of both stress and urge incontinence symptoms • Overflow incontinence is a steady loss of small amounts of urine when the bladder does not empty all the way during voiding. It can be caused by an underactive bladder ! muscle or blockage of the urethra. !What are the symptoms of urinary incontinence? !In addition to leaking urine, a woman with incontinence also may have other symptoms: • Urgency— A strong urge to urinate whether or not the bladder is full, often with pelvic ! pressure !• Frequency— Voiding more often than she considers usual !• Nocturia — The need to void during hours of sleep !• Dysuria — Painful voiding !• Enuresis— Bed-wetting or leaking while sleeping ! What causes urinary incontinence? ! Urinary incontience can have short-term causes and long-term causes. Short-term !causes are easier to treat and include the following: • Urinary tract infection— Loss of bladder control may be caused by an infection of the urinary tract. Infections of the bladder (cystitis) are common in women. These ! infections are treated with antibiotics. • Medications— Loss of bladder control may be a side effect of medications, such as ! diuretics. • Abnormal growths— Polyps, bladder stones, or less commonly, bladder cancer, can cause urinary incontinence. Abnormal growths often cause urge incontinence and may be associated with blood in the urine. If you see blood in your urine, or if you are unsure about the source of any bleeding, it is important to alert your health care ! provider right away. !Long-term causes include the following: • Pelvic support problems— The pelvic organs are held in place by supportive tissues and muscles. These supporting tissues may become torn or stretched, or they may weaken because of aging. If the tissues that support the urethra, bladder, uterus, or rectum become weak, these organs may drop down, causing urine leakage or making ! it hard to pass urine. • Urinary tract abnormalities— A fistula is an abnormal opening from the urinary tract into another part of the body, such as the vagina. It can allow urine to leak out through ! the vagina. • Neuromuscular problems—These disorders can interfere with the transmission of ! signals from the brain and spinal cord to the bladder and urethra. How is urinary incontinence diagnosed? ! A number of steps may be needed to find the cause of urinary incontinence. In some !cases, there may be more than one cause. You may be asked to keep a voiding diary for a few days in which you record the time and amount of urine leakage. You also should note how much liquid you drank and !what you were doing when a leak occurred. A pelvic exam will be done to detect physical conditions that might be linked to the problem. Lab tests also may be done to detect a urinary tract infection. Other tests that !assess how your bladder functions include the following: • Urodynamic tests— The bladder is filled through a catheter. These tests check the !function of the urethra and bladder. • Postvoid residual volume test—The amount of urine that is left in the bladder after !urinating is measured with an ultrasound device or by placing a catheter in the bladder. • Stress test— You are asked to cough a few times with a full bladder. Any loss of urine !is recorded. • Cystoscopy—A thin, lighted tube with a lens at the end is used to look inside the !bladder and urethra. How is urinary incontinence treated? ! There are many options for treatment. Often treatments are more effective when used in combination. Treatment options include lifestyle changes, bladder training, physical !therapy, devices, medications, bulking agents, and surgery. What are some of the lifestyle changes that are used to manage urinary incontinence? ! Making the following changes in your lifestyle, if they apply to you, may help the !problem: • Lose weight. In overweight women, losing weight has been shown to decrease the ! frequency of urine leakage. !• Avoid constipation. Repeated straining may damage the pelvic floor. !• Drink less fluids and limit intake of caffeine, which is a diuretic. !• Seek treatment for chronic coughing. !• Stop smoking. What is bladder training? ! The goal of bladder training is to learn how to control the urge to empty the bladder and increase the times between urinating to normal intervals (every 3–4 hours during the day and every 4–8 hours at night). After a few weeks of this training, leakage may occur less !often. ! What types of physical therapy are used to treat urinary incontinence? ! There are many types of physical therapy that can be done to treat urinary incontinence. One type, Kegel exercises, can help strengthen the pelvic muscles. Kegel exercises, along with bladder training and modifying fluid intake, are often very successful in !treating stress incontinence and urge incontinence. If you have trouble doing Kegel exercises, you may want to see a physical therapist who specializes in women’s pelvic health. Biofeedback is a training technique that may be !useful if you have problems locating the correct muscles. ! How are Kegel exercises done? ! !Kegel exercises tone your pelvic muscles. Here is how they are done: • Squeeze the muscles that you use to stop the flow of urine (but do not do these ! exercises while you are urinating). !• Hold for up to 10 seconds, then release. !• Do this 10–20 times in a row at least 3 times a day. Be careful not to squeeze the muscles of the leg, buttock, or abdomen. Do these exercises on a regular basis. It may take 4–6 weeks to notice an improvement in urinary !incontinence symptoms. What devices are used to treat urinary incontinence? ! A pessary is a device that is inserted into the vagina to treat pelvic support problems and urinary incontinence. Pessaries support the pelvic structures, and some compress the urethra. They come in all shapes and sizes. They are useful for women who do not !want or cannot have surgery to correct their incontinence. What medications are used for treatment? ! Drugs that help control muscle spasms or unwanted bladder contractions can help prevent leaks associated with urge incontinence. These medications also can help reduce the frequency of urination. During your consult we will help you decide which drug is most likely to work best for you. ! ! ! ! What are bulking agents? ! These agents may be used when the muscle surrounding the urethra is very weak and extensive surgery is not an option or has not worked. A substance is injected into the tissues around the urethra to add bulk. The urethra becomes narrowed, decreasing !leakage. This procedure can be done in a doctor’s office or clinic. What types of surgery treat urinary incontinence? ! Several surgical procedures have been developed to treat stress urinary incontinence (see Information on Surgery for Stress Urinary Incontinence). We will discuss which option may be best for you. You may need to adress other issues such as pelvic prolapse treatment as well. Any treatment and surgery, needs to indevidualized for you.